EIGHT STEP POSITIVITY PROCESS



PMP_SOCIALMEDIA-155436

Welcome to navigating with HIIN from the Hospital Improvement Innovation Network team at the Iowa Healthcare Collaborative. My name is Lana Comstock and thank you for joining us.

Today, we are going to have a discussion on the prescription monitoring program in Iowa and in South Dakota. I am pleased to introduce to you today subject-matter experts. First, we have Kristen Bunt, Director of Quality Integration with the South Dakota Association of Healthcare Organizations and Sarah Derr, Director of Medication Safety and Effectiveness. They are both my colleagues within the Compass HIIN. Sarah, I am going to direct my first question to you. Most listeners know that the State of Iowa has a Prescription Monitoring Program in that prescribers are required to use the PMP. But can you tell us specifically what the requirements are for use.

Thank you for having me today, Lana. With legislation passed in Iowa in 2018, prescribers will be required to register with the PMP starting in 2019. So each board, the Board of Medicine, Board of Nursing, Board of Physician Assistants have different ways of their doing this and slightly different rules. I have not yet seen the rules for each of these boards to date; however, they need to have them filed by the end of the year. From my understanding the Board of Pharmacy will tie the required registration with the controlled substance renewal licensing for any prescriber. So when the prescriber goes to renew their CSA, they will be directed to register with the PMP. Mandatory use has been discussed in the legislative sessions in the past few years; however, in Iowa it is not yet mandated. I expect this to come back in the 2019 session for further discussion.

That is good to know Sarah and I know that you watch the legislative happenings and communicate those within our HIIN so we can share that with our hospitals. Kristen, what are the similarities and what are the differences in the South Dakota PMP.

Thanks Lana for inviting us to also attend. So in South Dakota back in July of 2017 there was a requirement for all individual to carry a controlled substance registration through the South Dakota Department of Health were all required to have a prescription drug monitoring program login and along with that there was an additional couple of other bills that were passed at that same time. So beginning right away in 2017, they started to work towards having all of the pharmacists and anybody who had access into the prescription drug monitoring program needed to have access.

Very good. Kristen, do you anticipate any further legislative changes with the next session coming.

I do not believe so with the kind of over the last couple of years there have been further dialogue, on a yearly basis our session begins here in January and there is a requirement that South Dakota Board of Pharmacy had to present to our legislature both in the senate and in-house on a yearly basis. So there is always a potential that there could be new legislation coming out. But with that presentation, it will display all the work that has been occurring, so we are hopeful that there is not going to be any new legislation coming around.

Very good, thank you. Sarah, the Iowa PMP has 24-hour upload from pharmacies. Can you describe what that really means?

Sure, so the Iowa PMP does require any medication dispensed out of pharmacy to be uploaded into the PMP within one business day. So this has impacted the real-time fill of the PMP prior to our 2018 legislation passing, the pharmacy had up to seven days to upload and dispense medications to the PMP. In all honesty, there is only one state that has attempted to have real-time data and they had a very difficult time with technology. So at this point, I think the next business day mandate is as close as we are going to get to real-time.

That’s good to know for all of our providers that are inputting into that PMP. So Kristen in South Dakota who could access the PMP outside of the prescribing practitioners and what does access really mean in South Dakota.

Yeah, so obviously the prescribers and the pharmacists have an access. They can also delegate; however, a delegate must have a supervisor. That supervisor can be a prescriber or a pharmacist that has existing registration into the PMP. So delegates either are either prescriber delegated with the DEA, either has unlicensed or a pharmacist delegate that is unlicensed. Supervisors can also have more than one delegate and can review who is delegated underneath them as well. There is also an opportunity for law enforcement. There is some specific roles listed as far as if they are working specific case that they can then also gain access to the Department of Social Services for the purpose of utilizing controlled substance by Medicaid recipient, any insurer for the purpose also of utilizing the controlled substance by claimant, and then any judicial authority under grand jury subpoena or court order also has that availability. Any public or private for statistical research or educational purposes as long as the information is de-identified can also be used or can also gain access and then any peer review committee which means any committee of a healthcare organization or healthcare providers that employees, administrators, consultants, that type of group underneath the healthcare providers can also if they are conducting professional peer review.

Thank you Kristen. Hey Sarah, how does Kristen’s response compared to Iowa PMP rules?

Similarly to South Dakota, Iowa has up to six delegates for each prescriber. This means that the prescriber can have a medical assistance or a nurse accessing the information for them. Delegates may have more than one prescriber that they can access the PMP for. So that is why it gets a little confusing as each prescriber can have six delegates, but delegates can have multiple prescribers that they are accessing for. Outside of prescribers, pharmacists and delegates no one including law enforcement and patients can have access to the PMP directly. If there is an ongoing investigation or patient will like to access their own information in the PMP, they must submit a formal request to the Board of Pharmacy and again the Board of Pharmacy can do similarly to South Dakota some de-identified information for research purposes, but it is something that they have to go through the Board of Pharmacy to obtain that information. Kristen, what do you believe hospital clinicians who are not prescribers should know about the PMP and how could this translate into patient and family engagement.

So being that the PDMP is the statewide electronic database that collects designated data on the substances dispensed in the state, the PDMP also distributes that data from the database to individuals who are authorized and so I think it is important for them to know that it is a tool to use as information gathering and it is not a tool that is used for punitive. For hospitals, non-prescriber staff, the PDMP can be great at collecting controlled substance history. If the patient is not able to provide a complete dispensing history, if legally prescribed across most state lines, they can also gather that information. It can also be used to determine possible opioid misuse. Additionally, I think the PDMP can open up the dialogue between a patient and the prescriber and their care team, as well as the family in helping to make shared decisions. They can help to create a goal setting collaborative effort and breakdown any substance abuse stigma that can happen. Overall, I feel it supports the healthcare team along with the patient and family to make the best clinical decisions regarding the appropriate treatment and it reduces the likelihood of adverse drug events and gives the patient and family assistance if there is an addiction recognized.

Thank you. Sarah, I would like to ask you what would you forecast for Iowa’s legislative session this year.

Great question, Lana. I anticipate that there will be discussion about mandating the use and what that may look like. With the 2018 legislation passed around opioids, the Board of Pharmacy is required to share at least annual reports that compare prescribers to their peers when it comes to opioids and controlled substance prescribing, and I would anticipate that there may be additional legislation around, how to educate and share data with prescribers when it comes to the PMP, as well as how can we best share this information with our patients so they understand the purpose and use of the PMP.

Thank you Sarah. Thank you Kristen as well. Kristen, if our listeners want to reach out to you, how can you be reached.

Certainly, they can go to the website and then under the SDAHO tab and staff, you will find my e-mail which is located there and that is kristen.bunt@ or you can certainly give us a call. Our phone number here is 605-361-2281.

Thank you Kristen. And Sarah, how can you be reached if our listeners want to reach out to you. Same as with SDAHO, you can always go to and under staff find any of our staff there with e-mails. My direct email is derrs@ or you can always give me a call on my direct line at 515-283-9359.

This concludes our episode on prescription monitoring programs, and I want to thank Sarah and Kristen for taking their time to help us understand the PMP in Iowa as well as South Dakota.

If you would like more information or have a topic idea that you would like to request, please contact anyone on our HIIN team.

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